From the Kaiser Permanente Washington Research Institute, Seattle WA (LT, JDR, MFG); Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO (KSG, MD, RB, JLE, EAB); Center for an Informed Public, University of Washington, Seattle WA; Division of Research, Kaiser Permanente Northern California, Oakland, CA (RWG); Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (EAB).
J Am Board Fam Med. 2024 Mar-Apr;37(2):172-179. doi: 10.3122/jabfm.2023.230053R2.
Optimal care for persons with multiple chronic conditions (MCC) requires primary and specialty care continuity, access to multiple providers, social risk assessment, and self-management support. The COVID-19 pandemic abruptly changed primary care delivery to increase reliance on telehealth and virtual care. We report on the experiences of individuals with MCC and their family caregivers on managing their health and receiving health care during the initial pandemic.
Semistructured qualitative interviews with 30 patients (19 English speaking, 11 Spanish speaking) plus 9 accompanying care partners, who had 2+ primary care encounters between March 1, 2020, and November 30, 2020, 2+ chronic conditions, and 1 or more self-reported social risks. Questions focused on access to and experiences with care, roles for care partners, and self-management during the first 6 months of the pandemic.
Participants experienced substantial changes in care delivery. The most commonly reported changes were a shift to more virtual relative to in-person care and shifting roles for care partners. Changes fostered new perspectives on self-management and an appreciation of personal resilience and self-reliance. Virtual care was an acceptable complement to in-person care, though not a substitute for periodic in-person visits. It was more acceptable for English speakers and with a usual provider.
New models of care delivery that recognize patient and family resilience and resourcefulness, emphasize provider continuity, and combine virtual and in-person care may support self-management for individuals with MCC and social needs.
为患有多种慢性疾病（MCC）的人提供最佳护理需要初级保健和专科保健的连续性、获得多个提供者的机会、社会风险评估和自我管理支持。COVID-19 大流行突然改变了初级保健的提供方式，增加了对远程医疗和虚拟护理的依赖。我们报告了患有 MCC 的个人及其家庭照顾者在大流行初期管理自己的健康和接受医疗保健的经验。
对 30 名患者（19 名讲英语，11 名讲西班牙语）加上 9 名陪同照顾者进行半结构式定性访谈，他们在 2020 年 3 月 1 日至 11 月 30 日之间有 2 次以上的初级保健就诊，有 2 种以上的慢性疾病，并有 1 种或多种自我报告的社会风险。问题集中在护理的获取和体验、照顾伙伴的角色以及大流行前 6 个月的自我管理上。
参与者经历了护理提供方式的重大变化。报告最多的变化是更多地转向虚拟护理而非面对面护理，以及照顾伙伴角色的转变。这些变化促使人们对自我管理有了新的看法，并对个人的韧性和自力更生有了更多的赞赏。虚拟护理是面对面护理的一种可接受的补充，但不能替代定期的面对面就诊。对于讲英语的人和通常的提供者来说，它更能被接受。
新的护理提供模式认识到患者和家庭的韧性和足智多谋，强调提供者的连续性，并将虚拟护理和面对面护理结合起来，可能会支持患有 MCC 和有社会需求的个人的自我管理。
